Cervical cancer is the second most common cancer among women in Malaysia. The incidence rate for cervical cancer in Peninsular Malaysia is 13.4 in 100,000 for girls/women between 15 and 49 years of age, and 62.9 in 100,000 for women between 50 and 69 years of age, according to the 2003 Malaysian National Cancer Registry.
Although the benefits of cervical screening were described over seventy years ago, resource limitations have prevented achieving the benefits of cervical screening worldwide, particularly in developing countries, where prevalence of the disease is high. In Malaysia, Pap smear has been available since the 1960s. It remains the most effective strategy for the detection of precancerous state and consequent control of cervical cancer. If detected early, the disease is potentially curable.
- More than 3 sexual partners
- Early sexual intercourse (before 17 years of age)
- High parity (giving birth to 7 or more children)
- Low socio-economic status
Pain during sexual intercourse, abnormal vaginal bleeding / discharge after intercourse, post-menopausal vaginal bleeding, bleeding or spotting between periods, abdominal pain.
Screening and Diagnosis
A Papanicoloau (Pap) smear test is done by obtaining cervical cell samples with a spatula and/or brush. Once taken, it is smeared on a glass slide and fixed before being sent to the laboratory for staining and evaluation. Liquid-based cytology is a newer method which increases the sensitivity of screening. Please ask your healthcare provider for more information.
It is recommended to undergo annual Pap smear testing once a woman is sexually active. If the first two consecutive smear results are negative, screening every three years is recommended.
In the event that abnormal cells are detected on the Pap smear, your Gynaecologist will perform a colposcopy, which uses a lighted microscope to examine the external surface of the cervix during a pelvic examination. A small tissue sample (biopsy) of suspicious lesions is taken to aid in the diagnosis of micro-invasive cervical cancer. Once invasive cervical cancer is diagnosed, other imaging test eg. CT scan and intravenous urography will be done.
In general, the stages of cervical cancer are as follows:
Precancerous stage – Abnormal Pap smear, may potentially develop into cancer if left untreated
Stage I – Cancer confined to the cervix
Stage II – Cancer involving the upper vagina and some surrounding tissue
Stage III – Cancer spread to the lower vagina and more surrounding tissues (may affect kidneys)
Stage IV – Cancer has spread to another organ (also known as metastatic cancer)
Surgery is reserved for patients diagnosed with Stage 1 and some early Stage II cancers. Hysterectomy (removal of the uterus) may be performed in addition to removing the cervix. Both a cone biopsy (removal of the inside of the cervix where the cancer started growing) and a trachelectomy (removal of the upper vagina and cervix) are some surgical options. The uterus will not be removed if the woman wishes to preserve her fertility.
With more advanced / recurrent cancers, a procedure known as pelvic exenteration removes the uterus, surrounding lymph nodes, and parts of other organs surrounding the cancer. All the above procedures are performed by Gynaecologists with a subspecialty training in cancer surgeries.
Chemotherapy is given along with radiotherapy (Chemoradiation) for late stages of cancer (advanced stage II – IV). Together they give a better treatment response.
Radiation therapy can be external beam therapy (administered from an outside source of radiation) and brachytherapy (insertion of radioactive sources near the tumour for a fixed period of time). They are often administered together.
One of the major side effects of radiotherapy is narrowing of the vagina, which results in significant sexual impairment. Please speak to your Specialist with regards to treatment options.
Surgery, radiation, chemotherapy or a combination of the three may be used as the current standards of care for cervical cancer, depending on the stage of disease. However, in the last few years, a better understanding of human papillomavirus tumour-host immune system interactions and the development of new therapeutics targeting genes expression have renewed interest in the use of targeted therapy in cervical cancer patients.
Targeted therapy drugs work by attaching themselves to proteins or receptors on cancer cells, either killing the cells or helping other therapies, such as chemotherapy, work better. These targeted drugs work differently from standard chemotherapy drugs and often have different side effects. For instance, angiogenesis inhibitor targeted drug blocks the formation of new blood vessels that feed tumours, which can be used to treat advanced cervical cancer.
In Beacon Hospital, we understand that therapy drugs are costly, making them unaffordable for low-income patients. In response to this need, Beacon Hospital has introduced the Patient Assistant Programme for those who can’t afford the prescription drugs they need. These patients may be eligible for this Programme offered and managed by us.
Primary prevention involves getting vaccinated against the Human Papillomavirus (HPV). Virtually all cases of cervical cancer can be attributed to persistent HPV infection. However, secondary prevention by screening is still important as the HPV vaccine does not cover all the viral strains.
Having a regular Pap smear done is mandatory to detect precancerous changes, which can be treated before they progress to become cancer. No other cancer better documents the remarkable effects of prevention, early diagnosis and treatment on the mortality rate, so please arrange an appointment with your health care provider today.